EFFECTS OF TRAUMA ON CHILDREN

Armen Sarkissian, EdD HSPPCummins Behavioral Health Systems, IncOctober 15, 2011

DEFINITIONS

TRAUMATIC EVENTACTUAL OR THREATENED DEATH OR SERIOUS INJURY OR THREAT TO PHYSICAL INTEGRITYRESPONDED WITH INTENSE FEAR, HELPLESSNESS OR HORROR

DEFINITIONS…

TRAUMATIC EVENTEvents over which we have no controlPublic or Private Events

DEFINITIONS…

TRAUMATIC EVENTPUBLIC

Natural DisastersWarsTerrorismHostage situations

DEFINITIONS…

TRAUMATIC EVENT: PRIVATESexual Assault/RapeChildhood Physical AbuseChildhood Sexual AbuseChildhood NeglectBullyingVictim of, or Witness to ViolenceDomestic Violence

IMPACT OF TRAUMA

THE IMPACT OF TRAUMAS ARE CUMULATIVE. IF LEFT UNADDRESSED, TRAUMA UNDERLIES A WIDE RANGE OF SOCIAL, PHYSICAL AND BEHAVIORAL HEALTH PROBLEMS

IMPACT OF TRAUMA…

Trauma resulting from prolonged, repeated exposures to violent events can be the most severeTrauma, especially when untreated, can have severe negative impacts on a person’s physical and emotional well-being

IMPACT OF TRAUMA…

Persistent stress leads to:Elevations in heart rate, blood pressure, and stress hormones, which in turn impair:Brain architecture, immune status, metabolic systems, and cardiovascular systems

IMPACT OF TRAUMA…Exposure to traumatic events seems to change the way infants react to future stressorsAnimal and human studies show changes in hormones and brain chemicals after traumaThese brain changes can be long lasting, leading the child to feel numb or anxious

IMPACT OF TRAUMA…

SOCIALSCHOOL PROBLEMSHOMELESSNESSPROSTITUTIONDELINQUINCYCRIMINAL BEHAVIORINABILITY TO HOLD A JOB

IMPACT OF TRAUMA…PHYSICAL HEALTH

HEART DISEASECHRONIC LUNG DISEASELIVER DISEASEHIV-AIDSSKELETAL FRACTURESFIBROMYALGIA

IMPACT OF TRAUMA…

BEHAVIORAL HEALTH51 to 98 PERCENT OF CONSUMERS OF PUBLIC BEHAVIORAL HEALTH SERVICES HAVE TRAUMA HISTORIES

SAME PREVELANCE RATES AS SUBSTANCE ABUSE DISORDERS

IMPACT OF TRAUMA…

IN CHILDREN AND YOUTHTRAUMA RELATED DISORDERS ARE OFTEN INACCURATELY DIAGNOSED AS:

DEPRESSIONBIPOLAR DISORDERADHD/ADDODD

IMPACT OF TRAUMA…

IN CHILDREN AND YOUTHTRAUMA RELATED DISORDERS ARE OFTEN INACCURATELY DIAGNOSED AS…

SEPARATION ANXIETY DISORDERREACTIVE ATTACHMENT DISORDERCONDUCT DISORDERGENERALIZED ANXIETY DISORDERADJUSTMENT DISORDERS

IMPACT OF TRAUMA…

Life areas affected by trauma:

SafetyTrustPower and Sense of CompetenceSelf sufficiency, esteem, ability to self-soothe Intimacy

IMPACT OF TRAUMA…

Trauma perpetrated by humans seems to have a more severe and longer lasting impact on victims than natural disasters

IMPACT OF TRAUMA…

Trauma victims are at a much higher risk for co-occurring mental health and substance related disorders

TRAUMA VICTIMS…

Violence victimizationViolence perpetrationSelf-injuryHost of other coping mechanisms which themselves have devastating human, social, and economic costs

TRAUMA VICTIMS…

Trauma has been linked to:Hallucinations and delusionsDepressionSuicidal tendenciesChronic anxietyIrritabilityHostility and chronic anger

TRAUMA VICTIMS…

Trauma has been linked to…Interpersonal sensitivity or poor “social skills”Somatization such as “fibromyalgia”Eating disordersDissociation

TRAUMA VICTIMS…

IN CHILDREN AND YOUTH:Inability to have loving feelingsDevelopmental regressionNew separation anxietyNew onset of aggressionNew fearsDisruption of play activities

TRAUMA VICTIMS…

Disruption of play activities:Repetitive actionsDriven qualityConstricted qualityPreoccupation with separation, loss, and reunionLoss of play activities, in cases of neglect

DISASTER TRAUMA

All disaster victims are likely to experience some form of traumaMany disaster survivors “recover” from grief and shock after a few months25 percent to 30 percent of those directly affected may develop PTSD

DISASTER TRAUMA…

People are most at risk who have had:

Prior exposure to any trauma; domestic violence, childhood abuse, disaster, etcHistory of mental illness or drug abuse

Post Traumatic Stress Disorder

SYMPTOMS OF PTSD

TRAUMATIC EVENTREEXPERIENCING THE EVENTAVOIDANCEAROUSAL

PREVALENCE OF PTSD

50-60 percent experience a trauma over their lifetimeLifetime PTSD prevalence rate:

Men 5-8 percent Women 10-14 percent

PREVALENCE OF PTSD…

Lifetime PTSD prevalence rate8 percent in US population

PTSD rates increase with type and severity of trauma50 percent of those with PTSD experience it chronically

PREVALENCE OF PTSD…

Most clinicians in the field believe that the prevalence is much higher than what is being reported since most people are reluctant to admit or acknowledge trauma

Can PTSD be prevented?

Trauma is a necessary but not sufficient condition for developing PTSDThe “weak link”Unclear if early intervention is helpful, as was clear post 9-11 and post KatrinaSeems discussion and altruistic activities are helpful for adultsSpiritually oriented adults, cope better

Can PTSD be prevented?

Resilience in youth is a protective factor against developing PTSDIndividual and environmental factors play a partThe most important protective factor is a healthy and well functioning parent

COMORBID CONDITIONS

FOR YOUTH:DEPRESSIONBIPOLAR DISORDERANXIETY / PANICOPPOSITIONAL DEFIANT DISORDERADDICTIONSADD/ADHD

COMORBID CONDITIONSFOR YOUTH…

REACTIVE ATTACHMENT DISORDERDISRUPTIVE BEHAVIOR DISORDERSADJUSTMENT DISORDERSCONDUCT DISORDERSEPARATION ANXIETY DISORDERENURESIS, ENCOPRESISPSYCHOTIC DISORDERS

Assessing for Trauma…

Take every trauma seriously, even if not taken seriously by the reporterAllow the youth to postpone discussing the trauma to a later session

Assessing for Trauma…

Even if the PTSD criteria are not met, trauma may still cause stress in the individual’s life and ability to cope with life situations

Assessing for Trauma…

Trauma causes a change in persons’ view of themselves and of the world around them, as it applies to them

Recognizing Trauma

Discuss with youth information about trauma in general, the effect it has on people, and the availability of effective treatment when relevant

Trauma informed care

Trauma may be addressed while working on concurrent issues, such as substance related disorders, depression, anxiety, panic, oppositional disorders, attention deficit disorders, etc

FINANCIAL COSTS OF TRAUMA

The financial burden of undiagnosed and untreated trauma to society is staggering

FINANCIAL COSTS…

Alcohol and Drug Abuse treatment costs due to untreated trauma were estimated at $160.7 billion in 2000

FINANCIAL COSTS…

The estimated cost to society of child abuse and neglect is $94 billion per year, or $258 million per day

FINANCIAL COSTS…

Long-term psychiatric and medical health care costs are estimated at $100 billion per year for childhood abuse survivors

RESOURCES

Indiana Association for Infant and Toddler Mental Health (iaitmh.org) 317/638-3501 EXT 221Zero to Three (www.zerotothree.org)National Child Trauma Stress Network (www.nctsnet.org)

RESOURCES

mentalhealth.samhsa.gov/nctic

www.thriveintiative.org

www.chadwickcenter.org